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Post-Elimination Surveillance
Post-elimination surveillance –
case studies on leprosy in India
and onchocerciasis in Colombia
Post-elimination surveillance of leprosy:
Efforts to eliminate leprosy are close to being
realised, but complacency among the aid
community and poor quality, unreliable data risks
derailing this progress. For people affected by
leprosy, removing misconceptions and out-dated
understanding and raising public awareness of the
disease is critical to elimination efforts and also to
counter social stigma and discrimination.
Leprosy, once a major global public health
problem, is now considered by the WHO
as eliminated (less than 1 case per 10,000
population) from all but one country. India
achieved the target of leprosy elimination in 2005.
However, India still accounts for more than half of
the world’s disease burden (58%). India’s Leprosy
Eradication Programme has been reporting an
average increase of 5-7% in the Annual New Case
Detection Rate over the last five years 2 , including
a rise in the proportion of child cases. This is
due to lack of an efficient surveillance system
undertaken after elimination was declared to
trace contact and find cases.
This challenge underlines the need to ensure that
national drives to attain elimination status do not
rush or compromise leprosy prevalence surveys
and that data on the disease is collected in a
rigorous and robust way to ensure that hidden
pockets of leprosy in underserved communities
are not overlooked, and crucial leprosy elimination
programmes are not stopped prematurely.
The move to a post-elimination approach in
India has brought about a number of significant
challenges including low levels of political support
and shortage of resources such as insufficient
drugs and trained health workers in addition to
the lack of an efficient surveillance system for
relapse, drug resistance and treatment dropouts.
Moreover, waning political attention to the issue of
leprosy has meant that discriminatory laws, such as
those that consider leprosy as grounds for divorce and
those that prohibit leprosy sufferers from travelling on
the Indian railways, have not yet been abolished.
The evaluation report by the Global Alliance to
Eliminate Leprosy recommended that the WHO
should pass a resolution that makes it clear to the
world that leprosy has not been eliminated 3 . The
persistent advocacy efforts of the anti-leprosy
organisations have resulted in the WHO and
the Health Ministry of India re-evaluating the
usefulness of national elimination targets in large
diverse countries such as India, where some of
poorest states have pockets of high endemicity.
The National Leprosy Eradication Programme
(NLEP) has therefore come up with a Special
Activity Plan to target 209 highly endemic districts
by posting well trained District Leprosy Officers,
ensuring effective supervision and monitoring of
the programme and active engagement with local
NGOs to dispel stigma surrounding the disease.
A model for onchocerciasis elimination:
Colombia recently became the first country in the
world granted elimination status for onchocerciasis
by the World Health Organization. Led by the
Ministry of Health with a number of NGDO
and other partners, Colombia’s elimination
efforts were based on a strategy of twice yearly
community-wide administration of the medicine
ivermectin to all people in the afflicted area.
Credit: Lepra
Participant at a social audit of a leprosy programme in Bihar, India.
2
http://www.nlep.nic.in/pdf/Progress%20report%2031st%20March%202012-13.pdf
3
Indian Journal of Medical Research 137, January 2013, pp 15-35
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